21st Century
Pr Program Application
Olathe Leadership Studies
Thank you for your interest in our Olathe Leadership Studies program. We would like you to complete this application form to help us get to know you. Also, please review the attached Program Expectations form. This form includes the Leadership Studies Behavior Code.
Here’s how it works:
1. Complete this Student Application Form, Personal Statement of Interest Narrative and
Self-Evaluation.
2. Review and sign the attached Program Expectations form.
3. Submit this application and Program Expectations form to Janice Tusten in the office.
4. You will receive acknowledgement of your application.
5. Conference with program staff will be provided to you/your parents upon request.
Student Application
Student Name: ______________________________ Student ID #: ______________
Street Address: _________________________ City ____________ Zip: _________
Parent’s Email: ________________________________________________________
Home Phone: _________________________________________________________
Class: _______________________________________________________________
I am applying for the Olathe Leadership Studies 21st Century Program. I have discussed the program with my parents/guardians and they have indicated their permission for me to be considered for this program of study by their signature below.
_________________________________ __________________________________ Student Signature Date
_________________________________ __________________________________
Parent/Guardian Signature Date
Please answer each narrative question:
1. What activities, experiences or previous learnings stimulated your interest in this program area?
2. What ideas or plans do you have for your future career?
3. Please include a personal statement on what you hope to gain from the program, and what you have to offer the program.
Please list one teacher we could contact for a reference:
____________________________________
Please take a moment to rate yourself on a scale of 1-5 (1 being the least like you and 5 the most). All questions are required.
1. I am self-motivated and take pride in all projects
£ 1 £ 2 £3 £4 £5
2. I am creative and I am willing to listen to other people’s ideas.
£ 1 £ 2 £3 £4 £5
3. I have the ability to work on my own or in a group depending on what the situation demands.
£ 1 £ 2 £3 £4 £5
4. I have a passion for academic excellence and this program area.
£ 1 £ 2 £3 £4 £5
5. I am detail oriented and always finish what I start.
£ 1 £ 2 £3 £4 £5
6. I am organized.
£ 1 £ 2 £3 £4 £5
7. I have strong time-management skills.
£ 1 £ 2 £3 £4 £5
8. I have strong computer skills.
£ 1 £ 2 £3 £4 £5
9. I have strong communication skills (both verbal and written).
£ 1 £ 2 £3 £4 £5